Approaches to deprescribing cardiovascular medications in patients receiving palliative care: a scoping review

다국어 초록 (Multilingual Abstract)

This scoping review conducted from April 1, 2025, to May 31, 2025, aims to use palliative care as a valuable opportunity to reduce polypharmacy and enhance patient-centered care in the final days of life. To conduct this scoping review with systematic components, a database search was conducted on PubMed and EBSCO to identify studies focused on deprescribing cardiovascular medications in patients subject to polypharmacy in nursing homes. Eligible studies were inclusive of human patients aged 65 and older, patients receiving palliative care or with a limited life expectancy and focused on examining the effects of deprescribing practices and other outcomes affected. Study quality was assessed using the Cochrane Risk of Bias assessment tools RoB-2 and ROBINS-I. The quality assessment was performed by two reviewers, and discretion was discussed until consensus was achieved. In total, 31 studies met the inclusion criteria and were included in the discussion of the review, and 11 of those were included in the quantitative data analysis. There was a notable variation in both baseline medication uses and rates of discontinuation seen across the studies. Rates of deprescribing for antihypertensives varied widely, reported as low as 16.6% in large retrospective cohort studies and as high as 87.8% in structured intervention trials using specified guideline tools such as STOPPFrail. Deprescribing should be routine in palliative assessments, guided by frameworks that consider prognosis, symptoms, and patient values. Limitations of this scoping review include heterogeneity of the studies, which limits direct comparability between them and difficulty in generalizing the findings to a broader palliative care population and assessing the quality of life (QoL) as only a few studies used a validated instrument or patient outcome, but not all were able to assess them in the same manner. Due to the need for properly structured deprescribing guidelines, physicians lack the time and tools to utilize shared decision making to their advantage in many places. The findings from this review suggest that a tailored deprescribing strategy could effectively complement traditional pharmacological treatments by decreasing potential adverse effects and medication burden in vulnerable populations, especially those diagnosed with cardiovascular disease.